Has the mortality of septic shock changed with time

OBJECTIVES

To determine whether a systematic review of the literature could identify changes in the mortality of septic shock over time.

DATA SOURCES

A review of all relevant papers from 1958 to August 1997, identified through a MEDLINE search and from the bibliographies of articles identified.

DATA SYNTHESIS

The search identified 131 studies (99 prospective and 32 retrospective) involving a total of 10,694 patients. The patients' mean age was 57 yrs with no change over time. The overall mortality rate in the 131 studies was 49.7%. There was an overall significant trend of decreased mortality over the period studied (r=.49, p < .05). The mortality rate in those patients with bacteremia as an entry criterion was greater than that rate in patients whose entry criterion was sepsis without definite bacteremia (52.1% vs. 49.1%; chi2=6.1 and p< .05). The site of infection altered noticeably over the years. Chest-related infections increased over time, with Gram-negative infections becoming proportionately less common. If all other organisms and mixed infections are included with the Gram-positives, the result is more dramatic, with these organisms being causative in just 10% of infections between 1958 and 1979 but in 31% of infections between 1980 and 1997.

CONCLUSIONS

The present review showed a slight reduction in mortality from septic shock over the years, although this result should be approached with caution. The heterogeneity of the articles and absence of a severity score for most of the studies limited our analysis. Furthermore, there was an increasing prevalence of Gram-positive causative organisms, and a change of the predominant origin of sepsis from the abdomen to the chest.

Procalcitonin used as a marker of infection in the intensive care unit

OBJECTIVE

To determine the value of procalcitonin (ProCT) as a marker of infection in critically ill patients.

DESIGN

Prospective, observational study.

SETTING

Medicosurgical department of intensive care (31 beds).

PATIENTS

One hundred eleven infected and 79 noninfected patients.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

ProCT and C-reactive protein (CRP) concentrations were monitored daily. The best cutoff values for ProCT and CRP were 0.6 ng/mL and 7.9 mg/dL, respectively. Compared with CRP, ProCT had a lower sensitivity (67.6 vs. 71.8), specificity (61.3 vs. 66.6), and area under the receiver operating characteristic curve (0.66 vs. 0.78, p < .05). The combination of ProCT and CRP increased the specificity for infection to 82.3%. In the infected patients, plasma ProCT, but not CRP, values were higher in nonsurvivors than in survivors. Infected patients with bacteremia had higher ProCT concentrations than those without bacteremia, but similar CRP concentrations. ProCT levels were particularly high in septic shock patients.

CONCLUSIONS

ProCT is not a better marker of infection than CRP in critically ill patients, but it can represent a useful adjunctive parameter to identify infection and is a useful marker of the severity of infection.

Dairy augmentation of total and central fat loss in obese subjects

BACKGROUND AND OBJECTIVE

We have previously demonstrated an antiobesity effect of dietary Ca; this is largely mediated by Ca suppression of calcitriol levels, resulting in reduced adipocyte intracellular Ca2+ and, consequently, a coordinated increase in lipid utilization and decrease in lipogenesis. Notably, dairy Ca is markedly more effective than other Ca sources.

DESIGN

Obese subjects were placed on balanced deficit (-500 kcal/day) diets and randomized to control (400-500 mg Ca/day; n = 16) or yogurt (1100 mg Ca/day; n = 18) treatments for 12 weeks. Dietary macronutrients and fiber were held constant at the US average.

MEASUREMENTS

Body weight, body fat and fat distribution (by dual-energy X-ray absorptiometry), blood pressure and circulating lipids were measured at baseline and after 12 weeks of intervention.

RESULTS

Fat loss was markedly increased on the yogurt diet (-4.43+/-0.47 vs -2.75+/-0.73 kg in yogurt and control groups; P<0.005) while lean tissue loss was reduced by 31% on the yogurt diet. Trunk fat loss was augmented by 81% on the yogurt vs control diet (P<0.001), and this was reflected in a markedly greater reduction in waist circumference (-3.99+/-0.48 vs -0.58+/-1.04 cm, P<0.001). Further, the fraction of fat lost from the trunk was higher on the yogurt diet vs control (P<0.005).

CONCLUSION

Isocaloric substitution of yogurt for other foods significantly augments fat loss and reduces central adiposity during energy restriction..

In vivo diagnosis of cervical intraepithelial neoplasia using 337-nm-excited laser-induced fluorescence

Laser-induced fluorescence at 337-nm excitation was used in vivo to differentiate neoplastic [cervical intraepithelial neoplasia (CIN)], nonneoplastic abnormal (inflammation and human papilloma viral infection), and normal cervical tissues. A colposcope (low-magnification microscope used to view the cervix with reflected light) was used to identify 66 normal and 49 abnormal (5 inflammation, 21 human papilloma virus infection, and 23 CIN) sites on the cervix in 28 patients. These sites were then interrogated spectroscopically. A two-stage algorithm was developed to diagnose CIN. The first stage differentiated histologically abnormal tissues from colposcopically normal tissues with a sensitivity, specificity, and positive predictive value of 92%, 90%, and 88%, respectively. The second stage differentiated preneoplastic and neoplastic tissues from nonneoplastic abnormal tissues with a sensitivity, specificity, and positive predictive value of 87%, 73%, and 74%, respectively. Spectroscopic differences were consistent with a decrease in the absolute contribution of collagen fluorescence, an increase in the absolute contribution of oxyhemoglobin attenuation, and an increase in the relative contribution of reduced nicotinamide dinucleotide phosphate [NAD(P)H] fluorescence as tissue progresses from normal to abnormal in the same patient. These results suggest that in vivo fluorescence spectroscopy of the cervix can be used to diagnose CIN at colposcopy.

Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection

INTRODUCTION

Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection, although relatively common, remains controversial.

METHODS

Prospective, observational, multicenter study from 23 June 2009 through 11 February 2010, reported in the European Society of Intensive Care Medicine (ESICM) H1N1 registry.

RESULTS

Two hundred twenty patients admitted to an intensive care unit (ICU) with completed outcome data were analyzed. Invasive mechanical ventilation was used in 155 (70.5%). Sixty-seven (30.5%) of the patients died in ICU and 75 (34.1%) whilst in hospital. One hundred twenty-six (57.3%) patients received corticosteroid therapy on admission to ICU. Patients who received corticosteroids were significantly older and were more likely to have coexisting asthma, chronic obstructive pulmonary disease (COPD), and chronic steroid use. These patients receiving corticosteroids had increased likelihood of developing hospital-acquired pneumonia (HAP) [26.2% versus 13.8%, p < 0.05; odds ratio (OR) 2.2, confidence interval (CI) 1.1-4.5]. Patients who received corticosteroids had significantly higher ICU mortality than patients who did not (46.0% versus 18.1%, p < 0.01; OR 3.8, CI 2.1-7.2). Cox regression analysis adjusted for severity and potential confounding factors identified that early use of corticosteroids was not significantly associated with mortality [hazard ratio (HR) 1.3, 95% CI 0.7-2.4, p = 0.4] but was still associated with an increased rate of HAP (OR 2.2, 95% CI 1.0-4.8, p < 0.05). When only patients developing acute respiratory distress syndrome (ARDS) were analyzed, similar results were observed.

CONCLUSIONS

Early use of corticosteroids in patients affected by pandemic (H1N1)v influenza A infection did not result in better outcomes and was associated with increased risk of superinfections.

Merkel cell carcinoma (endocrine carcinoma of the skin) of the head and neck

Merkel cell carcinoma, also known as endocrine carcinoma of the skin, is a recently recognized and particularly aggressive form of skin cancer that exhibits histologic features similar to those of endocrine malignant neoplasms arising from other tissues. Forty-one patients with Merkel cell carcinoma arising from the cutaneous surfaces of the head and neck were seen at the University of Texas M. D. Anderson Hospital, Houston, between 1966 and 1983. Regional lymph node metastasis occur early and frequently, with a 79% overall incidence observed during the course of the disease. Treatment should consist of a wide resection of the primary tumor. A regional lymphadenectomy, when feasible, is successful in controlling nodal metastases. Postoperative radiation is recommended as an important adjuvant.

Fatty infiltration of the liver: quantification with phase-contrast MR imaging at 1.5 T vs biopsy

Quantification of hepatic fat content by application of MR phase-contrast imaging (Dixon method) at 1.5 T was compared with results of biopsy in 16 patients with a variety of liver abnormalities. Motion artifact was suppressed by employing six or eight averages of short TR in-phase (echo offset, 0 msec), out-of-phase (echo offset, 1.1 msec), and in-phase (echo offset, 2.2 msec) spin-echo pulse sequences. The 360 degree out-of-phase sequence was used to assess the impact of T2* decay on this method of estimating fat fraction. A standard two-echo long TR sequence also was obtained in all patients. Histologic preparations from the biopsy specimens were examined by a pathologist who had no knowledge of the MR results and were graded according to overall visual assessment as belonging to one of four categories of fat fraction. Results of the MR-calculated apparent fat fraction were compared directly with biopsy category and were also placed in MR fat fraction categories, allowing estimation of the statistical correlation between the biopsy and MR grading systems. Eight of eight patients with biopsy categories indicating a fat fraction of less than 0.25 were computed by MR to have a fat fraction of less than 0.1. Seven of eight patients with biopsy categories indicating a fat fraction of greater than 0.25 were computed by MR to have a fat fraction of at least 0.24. The MR-calculated apparent fat fraction category correlated significantly with the histologic biopsy category (r = .86, p less than .01). When compared with the in-phase image, decreased signal from liver was visually apparent on the 180 degree out-of-phase images in all cases in which the fat fraction was at least 0.24, but there was no indication of fatty liver on the standard T1- or T2-weighted images. Calculated T2 also showed no correlation with degree of fatty deposition. Correction for T2* decay by using the 360 degree out-of-phase acquisition in addition to the standard 0 degree and 180 degree out-of-phase images had little effect on fat fraction computation. Phase-contrast MR is a promising noninvasive method for quantitative assessment of fatty deposition in the liver.

Fluorescence spectroscopy: a diagnostic tool for cervical intraepithelial neoplasia (CIN)

A spectroscopic system incorporating a pulsed nitrogen laser, an optical fiber probe, and an optical multichannel analyzer was utilized to record fluorescence spectra of the intact cervix at colposcopy. Spectra were obtained from 66 colposcopically normal areas and 49 histologically abnormal areas (5 pathologic inflammation, 21 HPV infection, 9 CIN I, 10 CIN II, and 4 CIN III) in 28 patients. The resulting spectra could be used to differentiate histologically abnormal tissues from colposcopically normal tissues with a sensitivity, specificity, and positive predictive value of 92, 90, and 88%. Furthermore, CIN could be differentiated from nonneoplastic abnormal tissues with a sensitivity, specificity, and positive predictive value of 87, 73, and 74%. These results suggest that laser-induced fluorescence can be used in the recognition and differential diagnosis of CIN at colposcopy.

Lay person's perception of smile aesthetics in dental and facial views

OBJECTIVE

To compare the aesthetic perception of different anterior visible occlusions in different facial and dental views (frontal view, lower facial third view and dental view) by lay persons.

DESIGN

Cross-sectional survey, Lima, Peru, 2002.

SUBJECTS

The different views were rated by 91 randomly selected adult lay persons.

MAIN OUTCOME MEASUREMENT

Visual Analogue Scale (VAS) ratings of aesthetic perception of the views.

RESULTS

Anterior visible occlusion, photographed subject and view (p<0.001) had a significant effect on the aesthetic ratings. Also gender (p=0.001) and the interaction between gender and level of education (p=0.046) had a significant effect over the aesthetic rating.

CONCLUSIONS

A lay panel perceived that the aesthetic impact of the visible anterior occlusion was greater in a dental view compared with a full facial view. The anterior visible occlusion, photographed subject, view type are factors, which influence the aesthetic perception of smiles. In addition, gender and level of education had an influence.

Stimulation of hepatic mitochondrial alpha-glycerophosphate dehydrogenase and malic enzyme by L-triiodothyronine. Characteristics of the response with specific nuclear thyroid hormone binding sites fully saturated

Experiments were designed to analyze the relationship of a single i.v. dose of triiodothyronine (T3), the level of plasma and hepatic nuclear T3 attained, and the tissue response as reflected in increased activity of hepatic mitochondrial alpha-glycerophosphate dehydrogenase (alpha-GPD) and cytosol "malic enzyme" (ME). These studied were carried out in euthyroid rats by varying the dose of T3 injected and the time at which the animals were killed and the enzyme levels measured. The plasma T3 concentration was determined and the fraction of nuclear sites occupied at any time t was calculated from the known plasma:nuclear relationship. As a first step, the analysis was confined to the limiting situation in which all nuclear sites were effectively saturated. The following additional information was required and obtained: A proportional relationship between the half-neutralizing volume of a specific antiserum to malic enzyme and the activity of malic enzyme was established, thus confirming previous reports that the increase in enzyme activity induced by T3 is due to increased enzyme mass. The absolute refractory period immediately after i.v. injection of T3, during which no enzyme response could be detected, was determined. This was shown to be 13.4 h for alpha-GPD and 8.2 h for ME. Lastly, the t1/2 of the enzyme decay after pulse injection of T3 was measured. This was similar for both enzymes, 2.8+/-0.6 (SD) days for alpha-GPD and 2.7+/-0.6 (SD) days for ME. The results of these studies indicated that the extent of hepatic response appears limited by full occupancy of a set of intracellular receptor sites by T3 which is in rapid equilibrium with the plasma hormone pool. The kinetic properties of the receptors, as functionally defined in these studies, resemble those associated with the recently described specific nuclear T3 sites. These data per se are thus compatible with but do not prove a nuclear site of initiation of hormone effect. Thye do allow the development of an internally consistent mathematical model which permits prediction of enzyme response when the receptor sites are fully occupied for a given length of time after the i.v. injection of hormone. A separate series of studies was carried out in thyroidectomized rats. The response characteristics of alpha-GPD were similar to those observed in euthyroid animals. In contrast, however, the early response of ME to pulse injections of T3 was very much reduced in hypothyroid animals as compared to euthryoid animals in which nuclear sites were saturated for comparable periods. These findings raise the possibility that a factor required for the induction of malic enzyme but not alpha-GPD is deficient in the hypothyroid state.

Effect of visible light on selected enzymes, vitamins and amino acids

In most cases, the presence of an endogenous photosensitizer is a requirement for visible light modification of biomolecules in animal tissues. Riboflavin (RF) is present in all aerobic cells and is a very efficient photosensitizer, presenting a complex photochemistry with a mixed type I-type II mechanisms. Visible light irradiation in the presence of RF diminished the enzymatic activity of horse radish peroxidase (HRP) only when this glyco-enzyme was deglycosilated. In contrast, the activity of catalase is inactivated via singlet oxygen, and that of lysozyme was efficiently inactivated by a mixed type I-type II mechanisms. The reactive species involved in the RF sensitized photoconversion of lysozyme and the aromatic amino acids tryptophan and tyrosine (both free in solution) is discussed. The role of ascorbate and the effect of RF photosensitized processes in biological complex systems, such as the ocular lens and tumoral cell in culture, is analyzed.

Uterine papillary serous carcinoma (UPSC) treated with cisplatin, doxorubicin, and cyclophosphamide (PAC)

Uterine papillary serous carcinoma (UPSC) is an aggressive malignancy that accounts for a disproportionate number of intraabdominal failures among endometrial carcinoma patients. The histologic appearance and tendency toward intraabdominal spread resemble those of papillary serous adenocarcinoma of the ovary. Because approximately 70% of untreated ovarian carcinoma patients respond to platinum-based chemotherapy, it has been suggested that UPSC patients might respond to similar treatment regimens. Twenty patients with UPSC were treated with cisplatin, doxorubicin (Adriamycin), cyclophosphamide (PAC) chemotherapy between January 1982 and December 1989. They included 9 patients with advanced primary disease, 5 with recurrence, and 6 who received PAC as adjuvant therapy. Patients received a mean of five cycles of PAC. Only 2 of 11 patients with measurable disease greater than 2 cm achieved complete clinical responses of 12 and 31 months duration; there were no partial responses. Actuarial 5-year survival for all patients was 23%. The mean progression-free interval was 9 months. Patients with clinical stages I or II disease had a higher survival rate than those with stage III or IV disease (P = 0.003). Survival did not correlate with depth of myometrial invasion (P = 0.81) or size of residual tumor following initial surgery (P = 0.16). Estrogen or progesterone receptors were detected in 10 of 11 tumors tested. Seven of 9 patients tested had elevated serum levels of CA-125 (greater than 35 U/ml). Correlation between CA-125 value and clinical course was demonstrated in 3 of 5 patients who had serial measurements. Of all patients, 3 are currently alive; 1 has documented disease. Moderate to severe toxicity was seen in 14 patients (70%). There was one possible treatment-related death from cardiomyopathy. UPSC, despite its histologic and clinical similarities to ovarian carcinoma, was relatively resistant to PAC chemotherapy in this mixed group of patients.

Pertussis in Massachusetts, 1981-1991: incidence, serologic diagnosis, and vaccine effectiveness

Massachusetts provides diphtheria-tetanus toxoid-pertussis (DTP) vaccine, and since 1980 has monitored pertussis with a statewide diagnostic service. The incidence of bacteriologically confirmed pertussis was 104.5 per 100,000 person-years in 1-month-old infants and declined progressively thereafter. Infants < 6 months old experienced disproportionate morbidity: 44% of bacteriologically confirmed pertussis, 64% of hospitalizations, and 71% of hospital days. Most children with pertussis had received < 3 DTP doses during childhood, whereas 87% of adolescents with pertussis had received > or = 4 doses. Serodiagnosis by single serum anti-pertussis toxin antibody ELISA increased the incidence of confirmed pertussis in persons 11-19 years old from 3.0 to 12.9 per 100,000 and in persons > or = 20 years old from 0.16 to 0.56 per 100,000. Bacteriologic methods underestimate pertussis incidence, but a single serum anti-pertussis toxin antibody ELISA is a practical method for population-based diagnosis in adolescents and adults.

Promoting Global Research Excellence in Severe Sepsis (PROGRESS): lessons from an international sepsis registry

BACKGROUND

The PROGRESS Registry (Promoting Global Research Excellence in Severe Sepsis) was designed to provide comparative data reflecting everyday clinical practice, thereby allowing participating institutions to explore and benchmark medical interventions in severe sepsis.

MATERIALS AND METHODS

PROGRESS was an international, noninterventional, prospective, observational registry collecting data that describe the management and outcomes of severe sepsis patients in intensive care units (ICUs). Patients were enrolled who had been diagnosed with severe sepsis (suspected or proven infection and >or= 1 acute sepsis-induced organ dysfunction) at the participating institutions, where de-identified data were entered directly into a secured website. PROGRESS was governed by an independent international medical advisory board.

RESULTS

PROGRESS took place in 276 ICUs in 37 countries, and 12,881 patients were identified as having severe sepsis. There was considerable variation among countries in enrollment levels, provision of standard treatment and supportive therapies, and ICU and hospital outcomes. Eight countries accounted for 65.2% of the enrolled patients. Males (59.3%) and Caucasian (48.6%) patients predominated the patient cohort. Diagnosis of severe sepsis was prior to ICU admission in 45.7% of patients, at ICU admission in 29.1% of patients, and after ICU admission in the remainder. Globally, ICU and hospital mortality rates were 39.2% and 49.6%, respectively. The mean length of ICU and hospital stay was 14.6 days and 28.2 days, respectively.

CONCLUSIONS

The PROGRESS international sepsis registry demonstrates that a large web-based sepsis registry is feasible. Wide variations in outcomes and use of sepsis therapies were observed between countries. These results also suggest that additional opportunities exist across countries to improve severe sepsis outcomes.

Noxious colorectal distention induced-c-Fos protein in limbic brain structures in the rat

Colorectal distention is a non-invasive stimulus used to study visceral pain processing in the nervous system. In this study, immunocytochemical labeling for the immediate-early gene, c-Fos, was used to map limbic brain structures involved in processing visceral pain. Rats received noxious colorectal distention while loosely restrained or loose restraint without distention (control). The brains were immunostained and the density of Fos-labeled nuclei within areas of the brain associated with limbic function were examined. Many cortical (cingulate; retrosplenial; insular; perirhinal, entorhinal) and subcortical (periaqueductal gray; locus coeruleus; lateral parabrachial area; paraventricular, anterodorsal and centromedian thalamic nuclei; lateral septal area; dorsomedial hypothalamus; cortical amygdala; subiculum) areas were labeled in the control rats, but significantly more Fos was observed in these areas following noxious colorectal distention (CRD). Additional areas were labeled following CRD but not restraint (e.g. infralimbic and prelimbic cortices; mediodorsal thalamic nucleus; central amygdaloid nucleus). The results show that noxious visceral stimuli result in Fos expression in limbic structures that exceeds that induced by restraint stress, suggesting that different pathways and circuits are recruited by stimuli which can produce similar emotional responses.

Pesticides in Portuguese surface and ground waters

Pesticides used in Portuguese agricultural areas have been found in surface and ground waters. In the surface water collected in three river basins from 1983 to 1999, insecticides and herbicides were detected from the monitored pesticides, particularly atrazine, chlorfenvinphos (Z+E), alpha- and beta-endosulfan, lindane, molinate and simazine, reaching the maximum values, respectively, of 0.63, 31.6, 0.18 microg/L (alpha-endosulfan), 0.18 microg/L (beta-endosulfan), 0.24, 48 and 0.3 microg/L. In the ground water collected from the wells of seven agricultural areas from 1991 to 1998, several monitored herbicides were detected: alachlor, atrazine, metolachlor, metribuzine and simazine, reaching the maximum concentration values of 13, 30, 56, 1.4 and 0.4 microg/L, respectively. The herbicides more frequently detected were atrazine (64%), simazine (45%) and alachlor (25%). Other than these, the monitored pesticides can be present in Portuguese surface and ground waters. Therefore, to improve the analytical conditions, the use of multiresidue methods and automated techniques are desirable in future work.

Study of the fluorescence properties of normal and neoplastic human cervical tissue

Fluorescence excitation-emission matrices (EEMs) were obtained in vitro for 18 cervical biopsies from 10 patients. At all excitation emission maxima, but especially at 330 nm excitation, 385 nm emission, the average normalized fluorescence intensity of histologically normal tissue is greater statistically than that of histologically abnormal tissue. A diagnostic algorithm based on the relative intensity at 330 nm excitation, 385 nm emission can differentiate histologically normal and abnormal biopsies with a higher sensitivity (89%), but a lower positive predictive value (67%) and specificity (44%) than colposcopy (78%, 88%, 89%, respectively). However, paired comparison of histologically normal and abnormal biopsies from the same patient results in a sensitivity of 75%, positive predictive value of 86% and specificity of 88% for spectroscopic identification of histologic abnormality similar to that of colposcopy. This pilot study indicates that fluorescence spectroscopy may be useful in differentiating normal and abnormal tissue; based on these results, a strategy for in vivo studies is discussed.

Riboflavin-sensitized photoprocesses of tryptophan

The photodegradation of tryptophan in oxygen saturated aqueous solution sensitized by riboflavin is accompanied by the generation of the following reactive oxygen species: 1O2, OH., H2O2 and O2.-. When parallel photodegradation experiments are run with 14C-riboflavin in one case and 14C-tryptophan in the other and the irradiation products are separated by Sephadex G-15 and C18-HPLC, the generation of the following species is detected: aggregate forms of riboflavin, indolic products associated to flavins, indolic products of molecular weight higher than tryptophan, formylkynurenine, and other tryptophan photodecomposition products. The significance of the riboflavin anion radical and tryptophan cation radical as intermediates in the photoproduct formation is discussed.

Reflectance spectroscopy for in vivo characterization of ovarian tissue

BACKGROUND AND OBJECTIVE

To explore whether reflectance spectroscopy can differentiate normal ovary, benign neoplasms, and ovarian cancer.

STUDY DESIGN/MATERIALS AND METHODS

Reflectance spectra (390-600 nm) were measured at three source-detector separations (SDS) in vivo at 64 sites in 16 patients undergoing oophorectomy. Parameters with largest statistical differences were identified. Based on these parameters algorithms were developed and evaluated.

RESULTS

Promising parameters were the reflectance intensity from 540 to 580 nm (SDS, 1.1 mm), the slope of the reflectance spectrum from 490 to 520 nm (SDS, 1.1 mm), the slope from 510 to 530 nm (SDS, 2.1 mm), and the slope from 510 to 530 (SDS, 3 mm). Average sensitivity and specificity were 86 +/- 6% and 79 +/- 5% to separate normal ovary from benign neoplasms and cancers. Average sensitivity and specificity were 86 +/- 4% and 80 +/- 8% to separate ovarian cancers from benign neoplasms and normal ovary.

CONCLUSION

Reflectance spectroscopy should be further investigated for ovarian cancer screening.

Effects of vasoactive drugs on gastric intramucosal pH

OBJECTIVE

To review current knowledge about the effects of vasoactive agents on gastric intramucosal pH (pHi).

DATA SOURCES

All studies involving pHi and vasoactive agents were retrieved from a computerized MEDLINE search from 1980 to 1997. We also reviewed the reference lists of all available review articles and primary studies to identify references not found in the computerized searches.

STUDY SELECTION

Clinical and experimental studies using dopamine, dopexamine, dobutamine, norepinephrine, epinephrine, nitric oxide, N-acetylcysteine, prostaglandins, or pentoxifylline were considered if splanchnic perfusion and/or pHi measurements were utilized.

DATA EXTRACTION

From the selected studies, information was obtained regarding patient population, dosing regimen, duration of study, and effects on splanchnic blood flow (SBF), splanchnic oxygenation, and pHi.

DATA SYNTHESIS

Although dopaminergic effects increase SBF, dopamine does not generally increase pHi. Data on the effects of dopexamine on pHi are scarce and inconsistent. Dobutamine can significantly increase SBF and usually increases pHi. In septic patients, norepinephrine seems to increase pHi. Epinephrine may have detrimental effects on gastric perfusion. Prostacyclin seems to increase pHi but data are limited. Insufficient evidence exists to support the beneficial effects of nitric oxide donors or blockers, pentoxifylline, or N-acetylcysteine on pHi.

CONCLUSIONS

Overall, the effects of vasoactive agents on pHi are unpredictable. Among the catecholamines, dopamine is the least likely, and dobutamine the most likely, to increase pHi.

Association of Streptococcus bovis bacteremia with bowel disease

We reviewed the medical records of 19 patients who had Streptococcus bovis bacteremia. Eight patients had diverticulosis, four had benign adenomatous colonic polyps, and three had adenocarcinomas of the gastrointestinal tract. Laboratory workers and clinicians should be aware of the association of S. bovis bacteremia and gastrointestinal disease.

Protein kinase WNK2 inhibits cell proliferation by negatively modulating the activation of MEK1/ERK1/2

The recently identified subfamily of WNK protein kinases is characterized by a unique sequence variation in the catalytic domain and four related human WNK genes were identified. Here, we describe the cloning and functional analysis of the human family member WNK2. We show that the depletion of endogenous WNK2 expression by RNA interference in human cervical HeLa cancer cells led to the activation of the extracellular signal-regulated kinase (ERK)1/2 mitogen-activated protein kinases but, in contrast to the depletion of WNK1, had no effect on ERK5. Furthermore, expression of a kinase-dead WNK2-K207M mutant also activated ERK1/2 suggesting that WNK2 catalytic activity is required. Depletion of WNK2 expression increased G1/S progression and potentiated the cellular response to low epidermal growth factor concentrations. The molecular mechanism of ERK1/2 activation in WNK2-depleted cells lies downstream of the Raf kinases and involves MEK1 phosphorylation at serine 298 in both HeLa and HT29 colon cancer cells. This modification is linked to the upregulation of MEK1 activity toward ERK1/2. Together, these results provide evidence that WNK2 is involved in the modulation of growth factor-induced cancer cell proliferation through the MEK1/ERK1/2 pathway. The data identify WNK2 as a candidate tumor suppressor gene and suggest a coordinated activity of WNK kinases in the regulation of cell proliferation.